Cremation Authorization Form

Name of Crematory Establishment:

St. Louis Cremation

Name of Funeral Establishment:

St. Louis Cremation

I, the undersigned, hereby authorize the crematory and funeral establishment named above to cremate the remains of:

Name of Person to be Cremated:

I hereby certify that I am the nearest degree of relationship to the deceased and that I have the legal right or am charged to authorize this cremation and the disposal of the cremated remains,. I understand that due to the nature of the cremation process, any personal possessions or valuable materials, such as dental gold or jewelry (as well as any body prosthesis or dental bridgework), that are left with the decedent and are not removed prior to cremation will be destroyed or if not destroyed, will be disposed of by St. Louis Cremation Service. I further agree that I will indemnify and hold harmless the Cremator and Funeral Director, their officers and employees from any liability, costs, expenses or claims resulting from this authorization.

I request that following cremation, the funeral home make disposition of the cremated remains as follows:

I specifically agree that if the said cremains are left in the custody of St. Louis Cremation for over thirty (30) days, St. Louis Cremation make whatever disposition of the cremains it deems appropriate.